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BMJ Case Rep. 2016; 20: bcr2016217543. Aortic dissection (AD) is a life-threatening condition and may present with symptoms which mimic myocardial infarction, leading to misdiagnosis and inappropriate use of anticoagulant and thrombolytic therapy. Sinus of valsalva aneurysm is a rare, often congenital, cardiac condition. The reported incidence of acute myocardial infarction as a complication of aortic dissection is 1% to 2% of all cases. The morbidity rate of acute aortic dissection (AD) is 6 cases per 100,000 person-years (1). Also, vomiting, sweating, and lightheadedness may occur. Type A aortic dissection with concurrent ST-elevation myocardial infarction (STEMI) is relatively rare. Unless there is timely treatment, this results in myocardial ischemia followed by infarction. The patient arrested and could not be resuscitated. Images 74, 75, 76 demonstrate reduced first pass enhancement of the myocardial wall (posterior interventricular septum and posterior left ventricular wall). (J Interven Cardiol 2015;28:117–118) Thirty‐two‐year‐old woman was admitted to the emergency department for 2 hours chest pain. Type A aortic dissection with concurrent ST-elevation myocardial infarction (STEMI) is relatively rare. A 60-year-old man had had AVR for aortic regurgitation. Myocardial ischemia secondary to dissection of the ascending aorta remains a relatively rare complication. The pattern of care and outcomes of the very young with ST-segment elevation myocardial infarction is therefore not well defined [1, 2]. Anti-Impulse therapy: Use IV beta-blockers or calcium channel blocker. Difficult appreciate these findings on these JPEG images. Aortic dissection detection risk score(ADD-RS)[6] is a highly sensitive bedside clinical tool used to assess the risk of acute aortic dissection based on high-risk conditions, pain, and examination features. List the complications of MI and give an example of each. A 76-year old man with no prior history developed sudden chest pain. The incidence of myocardial ischemia in aortic dissection ranges from 1% to 5%. as aortic/coronary dissection, thromboembolism, septic emboli, or trauma. Aortic dissection is the prototype and most common form of the acute aortic syndromes and a type of arterial dissection.It occurs when blood enters the medial layer of the aortic wall through a tear or penetrating ulcer in the intima and tracks longitudinally along with the media, forming a second blood-filled channel (false lumen) within the vessel wall. The diagnosis was facilitated by urgent echocardiography, a CT aortogram and invasive coronary angiography to exclude aortic dissection and myocardial infarction, respectively. In this, chapter we will analyse mechanical complications, such as ventricular free wall rupture, ventricular septal defect, papillary muscle rupture, ischaemic mitral regurgitation, left ventricle aneurysm, and cardiogenic shock. Clinical Research in Cardiology, 2011. In most patients, the inferior myocardium is supplied by the right coronary artery. A retrograde extension of AAD can lead to partial or complete occlusion of coronary vessels, leading to an exceedingly rare presentation in the form of acute Myocardial Infarction (MI). Inferior myocardial infarction: When the ascending aortic dissection involves the ostium of the right coronary artery, an inferior myocardial infarction can occur. The possibilities of both, acute mechanical complications of myocardial infarction, and acute aortic dissection were sought of. Inappropriate administration of thrombolytic therapy to such patients can result in catastrophic outcomes. - … Replacements of aortic valve and ascending aorta with CABG We report a case of a patient with an inferior STEMI thrombolysed with … The incidence of IE in the United States is 15 per 100,000 population; however, it is much higher in those with congenital bicuspid aortic … These medications reduce blood pressure and left ventricular contraction = less shear wall stress of aorta and reduces dissection propagation. Misdiagnosis will lead to inappropriate administration of anticoagulant and thrombolytic therapy and delayed surgical repair of the aorta. A short summary of this paper. A 69-year-old man with a history of hypertension was referred to our institution for management of acute myocardial infarction (AMI) and cardiogenic shock. Aortic dissection (AD) occurs when an injury to the innermost layer of the aorta allows blood to flow between the layers of the aortic wall, forcing the layers apart. Myocarditis, pericarditis, and musculoskeletal thoracic pain are also differentials of myocardial infarction and are Computed tomographic aortography (CTA) depicted ascending aortic dissection (AAD) with involvement of bilateral carotid, subclavian, and right common iliac arteries (Figure 1B). Aortic dissection (AD) is a life-threatening condition and may present with symptoms which mimic myocardial infarction, leading to misdiagnosis and inappropriate use of anticoagulant and thrombolytic therapy. This has been outlined. We report a case of a 60-year-old male who presented with inferior wall ST-elevation myocardial infarction (MI). Aortic dissection can be presumed in patients with symptoms and signs suggestive of myocardial infarction but without classic electrocardiographic (ECG) findings. Kodera S, Ikeda M, Sato K, Kushida S, Kanda J. Percutaneous coronary intervention is a useful bridge treatment for acute myocardial infarction due to acute type A aortic dissection. Background: Evidence between admission systolic blood pressure (SBP) and in-hospital deaths in acute type A aortic dissection (AAD) patients is inadequate. Electrocardiography was consistent with an acute inferior myocardial infarction. Approximately 7% of patients with the AD have concomitant acute myocardial infarction (AMI) (2). Electrocardiogram (ECG) changes in anterolateral ST elevation myocardial infarction (STEMI). Left ventricular free wall rupture (LVFWR) is a rare complication that can occur after suffering a myocardial infarction (MI). contractile dysfunction. Complications of acute myocardial infarction are different and life threatening. Inferior myocardial infarction secondary to aortic dissection associated with bicuspid aortic valve Cai, J. and Cao, Y. and Yuan, H. and Yang, K. and Zhu, Y.-S. Journal of … Myocardial infarction (MI), colloquially known as a heart attack, an acute coronary syndrome, results from interruption of myocardial blood flow and resultant ischaemia and is a leading cause of death worldwide. Routine cardiac intervention with emergent cardiac catheterisation may lead to a higher mortality rate in this … Acute myocardial infarction can be a huge distractor when it complicates an acute ascending aorta dissection. Emergent coronary angiography revealed an ascending aortic dissection with normal coronary arteries. She takes oral contraceptive pills to avoid pregnancy. Aortic dissection after cocaine abuse. Start studying AIT 2-2 Syndromes with acute chest pain (aortic dissection, acute myocardial infarction, pneumothorax). Acute myocarditis was later confirmed on cardiac MRI. We present a case of inferior wall AMI caused by type I aortic dissection … [ 1] Painless dissection is more common in those with neurologic complications from the dissection and those with Marfan syndrome. The independent and dependent variables targeted were admission … In most cases, this is associated with a sudden onset of severe chest or back pain, often described as "tearing" in character. Abstract. Acute Myocardial Infarction (MI) due to hypoperfusion of the coronary artery is an exceedingly rare finding in AAD, but it is potentially fatal. Acute ST segment elevation myocardial infarction (STEMI) is typically associated with acute coronary thrombosis or plaque rupture. Aneurysm, Dissecting/diagnostic imaging* Aortic Aneurysm/diagnostic imaging* However, it can be potentially fatal and easily misdiagnosed as STEMI alone. Learn vocabulary, terms, and more with flashcards, games, and other study tools. J Cardiothorac Surg 2011; 6: … PubMed: https://pubmed.ncbi.nlm.nih.gov/27999129/ Chen A, Ren X. Aortic Dissection Manifesting as ST-Segment-Elevation Myocardial Infarction. Silvia Bugatti Key Points • Pregnancy increases the risk or aortic dissection by 25-fold above the baseline for the general population • The most common risk factor for aortic aneurysm and dissection is hypertension that is most frequently encountered in the third trimester of pregnancy • Spontaneous coronary artery dissection is the most common cause of myocardial infarction in pregnancy Note the reciprocal ST depression in the inferior leads. It seems to be likely, that the initial event was a type A aortic dissection causing first an inferior myocardial infarction by the dissection of the RCX. ... Post-MI pericarditis or aortic dissection may also cause pericardial effusion. Abstract. Among patients suffering from acute myocardial infarction, 70% of fatal events are due to occlusion from atherosclerotic plaques. A Type A Aortic Dissection Mimicking an Acute Myocardial Infarction. Complications encountered during surgery for aortic stenosis can be associated with catastrophic events such as myocardial infarction, cerebral embolism or aortic dissection. We describe a case of a female aged 55 years, presenting with an acute inferior ST-elevation myocardial infarction. We describe a case of a female aged 55 years, presenting with an acute inferior ST-elevation myocardial infarction. A high index of suspicion by using the general clinical picture is needed to establish the diagnosis. Additionally, inferior wall MI can present with bradycardia because of vagal stimulation.2 What Is the Pathogenesis of MI? Aortic dissection (AD) is a life-threatening condition and may present with symptoms which mimic myocardial infarction, leading to misdiagnosis and inappropriate use of anticoagulant and thrombolytic therapy. pericarditis. The coronary ischaemia has resulted from a spontaneous right coronary artery dissection due to a right coronary cusp sinus of valsalva aneurysm (SVA). Tsigkas G, Kasimis G, Theodoropoulos K, Chouchoulis K, Baikoussis NG, Apostolakis E, et al. The incidence of IE in the United States is 15 per 100,000 population; however, it is much higher in those with congenital bicuspid aortic … Target a heart rate of < 60 and a systolic blood pressure between 100-120 mmHg. Prompt diagnosis and therapy are essential. These medications reduce blood pressure and left ventricular contraction = less shear wall stress of aorta and reduces dissection propagation. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Aortic dissection mimicking inferior ST-elevation myocardial infarction has been previously described, with misdiagnosis due to time pressures.8 9 Anterior ST-elevation myocardial infarction is rare but can occur due to compression of coronary ostia by haematoma, or occlusion by extension of the dissection … Chest Trauma in athletes is a common health problem. Furthermore, all other causes of thoracic pain have to be distinguished from myocardial infarction, including lung embolism, aortic dissection, tension pneumothorax, and spontaneous rupture of the esophagus (Boerhaave-syndrome). [ 1] Painless dissection is more common in those with neurologic complications from the dissection and those with Marfan syndrome. As a result of similarities in clinical risk factors and presentations, AD can mimic acute myocardial infarction (AMI). A: Initial ECG on presentation shows ST segment elevation in the precordial leads, as well as I and aVL, indicative of acute anterolateral STEMI due to proximal left anterior descending (LAD) coronary artery occlusion. Inferior myocardial infarction secondary to aortic dissection associated with bicuspid aortic valve. The pattern of care and outcomes of the very young with ST-segment elevation myocardial infarction is therefore not well defined [1, 2]. Patients presenting with acute chest pain, electrocardiography (ECG) changes of acute inferior myocardial infarction, and a previously undocumented murmur of aortic insufficiency (AI) are of particular concern for a type I aortic dissection into the right coronary artery (causing inferior myocardial infarction), and the aortic valve (causing AI). We report a case of a patient with an inferior STEMI thrombolysed with tenecteplase and followed by clinical and electrocardiographic evidence of successful reperfusion, which was found later to be a lethal acute aortic dissection. We present a case of a pan-aortic dissection (AD) with multi-system organ failure and shock presenting as anterior spinal cord syndrome, inferior myocardial infarction and stroke. Aortic dissection is an important cause of acute chest pain that should be rapidly diagnosed, as mortality increases with each hour this condition is left untreated. Cardiology Research, 2012. Computed tomographic aortography (CTA) depicted ascending aortic dissection (AAD) with involvement of bilateral carotid, subclavian, and … Thrombolysis, a standard therapy for ST elevation myocardial infarction (STEMI) in non-PCI-capable hospitals, may be catastrophic for patients with aortic dissection leading to further expansion, rupture and uncontrolled bleeding. Figure 8–1. Ascending aortic dissection presented as inferior myocardial infarction: a clinical and diagnostic mimicry. Myocardial infarction may thus occur in a benign form during aortic valve replacement, but it may also be a fatal event and in this series accounted for four of the five deaths. Acute aortic dissection complicated with acute myocardial infarction (AMI) is the most fatal situation. Stanford type A aortic dissection, rarely may mimic myocardial infarction. Aortic dissection can present with a wide range of manifestations and is easily misdiagnosed. Target a heart rate of < 60 and a systolic blood pressure between 100-120 mmHg. revealed inferior wall myocardial infarction with suspected right ventricular involvement (Figure 1A). PMCID: PMC4804865. Patient Data. Extensive aortic dissection presenting as acute inferior myocardial infarction. Aortic dissection can present with a wide range of manifestations and is easily misdiagnosed. Aortic dissection (AD) is a life-threatening illness that has a wide range of manifestations. The patient decompensated. Ascending aortic dissection presented as inferior myocardial infarction: a clinical and diagnostic mimicry. No Chest Xray was performed and the patient received thrombolytics. In Misdiagnosis will lead to inappropriate administration of anticoagulant and thrombolytic therapy and delayed surgical repair of the aorta. 94 Heart 1998;80:94–97 CASE REPORT Unruptured left ventricular pseudoaneurysm following myocardial infarction M-J Hung, C-H Wang, W-J Cherng Abstract changes in a 12 lead electrocardiogram and A 73 year old man developed a left raised creatine kinase (up to 3746 IU/l with MB ventricular pseudoaneurysm following form of 8.5%). When the pain is located in the epigastric area and is associated with nausea and vomiting, the clinical picture can be confounded with acute cholecystitis or peptic ulcer. Inferior wall myocardial infarction (MI) occurs from a coronary artery occlusion with resultant decreased perfusion to that region of the myocardium. Stanford type A aortic dissection, rarely may mimic myocardial infarction. 7. Thrombolysis, a standard therapy for ST elevation myocardial infarction (STEMI) in non-PCI-capable hospitals, may be catastrophic for patients with aortic dissection leading to further expansion, rupture and uncontrolled bleeding. R. Ieva. However, dissection and myocardial infarction occur concomitantly in from 1.5 to 7.5% of cases and the involvement of the right coronary artery is more common than the left coronary artery [2,8], a fact that could justify in part, the horizontal depression found in the … Surgery is the first choice for AMI secondary to aortic dissection caused by extension of dissection into the coronary arterial wall. The inferior lateral wall was hypokinesia, and the right ventricle wall was akinetic. [3–5] A study by Asouhidou et al. While serious efforts have been made to shorten door-to-balloon time, 1, 2 some patients who are initially diagnosed with STEMI actually have conditions other than myocardial infarction, such as Brugada syndrome, subarachnoidal hemorrhage, myocarditis, pericarditis and aortic dissection. Basedonthe clinical ... and tachycardia. There was an underlying thoracic aortic dissection. The initial ECG demonstrated inferior ST-segment elevation with reciprocal anterior changes. This paper. Aortic dissection can be presumed in patients with symptoms and signs suggestive of myocardial infarction but without classic electrocardiographic findings. However, dissection and myocardial infarction occur concomitantly in from 1.5 to 7.5% of cases and the involvement of the right coronary artery is more common than the left coronary artery [2,8], a fact that could justify in part, the horizontal depression found in the … However, it can be potentially fatal and easily misdiagnosed as STEMI alone. Also, vomiting, sweating, and lightheadedness may occur. progressive heart failure. Upon arrival, he received anticoagulation and antiplatelet aggregation … In one of these five patients (patient 7), despite successful stenting, temporary prestenting obstruction of the right coronary artery was associated with periprocedural inferior left ventricular myocardial infarction (concentration of creatine kinase, myocardial bound, 59.5 U/L) and right ventricular dysfunction. A case of acute aortic dissection complicating acute inferior myocardial infarction diagnosed by accidentally inserting the catheters into the false lumen during the emergency cardiac … Acute ST segment elevation myocardial infarction (STEMI) is typically associated with acute coronary thrombosis or plaque rupture. Consistent with acute myocardial ischemia and infarction including: ST elevation MI (STEMI) Non-ST Elevation MI (Non-STEMI) ... aVL, V5, V6 Left Circumflex (LCX) Inferior Leads II, III, and aVF Right Coronary Artery (RCA) p: 1. In most cases, this is associated with a sudden onset of severe chest or back pain, often described as "tearing" in character. Introduction: Acute aortic dissection is the most common catastrophic event affecting the aorta. Prognostic implications of early Case Presentation: A 62-year old woman with history of tobacco abuse and Score 2–3 (high risk): Expedite definitive imaging. Tarver K(1), Kindler H, Lythall D. Author information: (1)ktarver@doctors.org.uk PMCID: PMC2000954 PMID: 17890699 [Indexed for MEDLINE] Publication Types: Case Reports; MeSH terms. The symptoms of aortic dissection may be variable and can mimic other more common conditions such as myocardial ischemia. In the current era of primary percutaneous coronary intervention with emphasis on door-to-balloon time, aortic dissection should be part of the differential diagnosis of ST-segment–elevation myocardial infarction. Stanford type A aortic dissection, rarely may mimic myocardial infarction. 3 This occurs when a proximal dissection flap involves the ostium of a coronary artery. Rarely, STEMI can be associated with ascending aortic dissection, which represents the majority of acute aortic syndrome aetiologies and carries dreadful outcomes. However, further evaluation with computed tomographic angiogram done revealed DeBakey's type 1 or Stanford type A AoD. The electrocardiogram showed a ST-segment elevation in leads II and III suggesting an inferior wall acute myocardial infarction. Aortic dissection; Excess demand on the heart (hyperthyroidism, anemia) Epidemiology. The ECG showed a marked ST-segment elevation in leads II, III, and aVF and a reciprocal ST-segment depression in leads V2 through V6, suggesting an inferior wall AMI ( Figure 1 ). E. Aortic dissection. The initial echocardiography depicted moderate pericardial effusion without tamponade. 37 Full PDFs related to this paper. Echocardiography is an important tool for the differential diagnosis. We report a case of acute inferior wall myocardial infarction following blunt chest trauma. Download PDF. Given the ECG and echocardiographic findings, and the patient was in severe pain, we decided to proceed with CT aortogram to rule out aortic dissection. We report a case of a patient with an inferior STEMI thrombolysed with … -risk factors for complications include: female, advanced age, DM, previous MI. ar-old man was found unconscious and diaphoretic with labored respirations by the paramedics. However, myocardial infarction secondary to coronary dissection in the setting of blunt chest trauma is extremely rare. A 12-lead electrocardiogram showed atrioventricular (AV) dissocation with ST segment elevation in the inferior leads. Sinus of valsalva aneurysm is a rare, often congenital, cardiac condition. Typically occurs with inferior or posterior MI, affecting the posterio-medial valve leaflet (figure above). We experienced the successful treatment for acute type A aortic dissection complicated with inferior AMI following aortic valve replacement (AVR). Acute myocardial infarction (AMI) due to acute aortic dissection is not frequent.12An early diagnosis is essential to improve the patients' prognosis.3We report a case of an Japanese woman with an acute inferior myocardial infarction secondary to an acute aortic dissection, which was ignored in the early stages despite investigation in hospital. Emergent coronary angiography revealed an ascending aortic dissection with normal coronary arteries. Aortic dissection (AD) occurs when an injury to the innermost layer of the aorta allows blood to flow between the layers of the aortic wall, forcing the layers apart. Alsaad AA, Odunukan OW, Patton JN. The diagnosis can be challenging, especially if concomitant myocardial infarction is present. Case Report: Here we report a case of aortic dissection that was initially misdiagnosed as inferior wall myocardial infarction although the initial symptoms were related to right subclavian artery occlusion caused by a dissection flap. ... For decompensation after myocardial infarction, echocardiogram is critical to evaluate for a diverse range of complications. However, AMI secondary to aortic dissection is a rare condition, which might be caused by compression of the coronary arteries by a hematoma or extension of the dissection into the coronary arterial wall. We would like to thank Dr. A. Johnson, Mr. K. Ross, and Mr. J. L. Monro for permission to study their patients and Miss D. Lansley and Miss S. Trevett for secretarial help. Read Paper. BMJ Case Rep. 2016. Aortic dissection is painless in about 10% of patients. Involvement of the right coronary artery can occur in the setting of painless acute aortic dissections. Download Full PDF Package. Electrocardiogram revealed inferior wall myocardial infarction with suspected right ventricular involvement (Figure 1A). We report a case of a 60-year-old male who presented with inferior wall ST-elevation myocardial infarction (MI). Give aspirin 162-325mg PO or rectally, oxygen and NTG – if no contraindication exists for NTG (e.g. The coronary ischaemia has resulted from a spontaneous right coronary artery dissection due to a right coronary cusp sinus of valsalva aneurysm (SVA). A diagnosis of inferior myocardial infarction was made based on ST-Segment elevation >2 mm in the Leads II, III and aVF on electrocardiogram (ECG). arrhythmia. ... is a complication of an inferior wall myocardial infarction due to papillary muscle dysfunction or rupture which also occurs a few days after MI. Aortic dissection is painless in about 10% of patients. Nausea and vomiting are more frequent with inferior location of myocardial infarction. Rarely, STEMI can be associated with ascending aortic dissection, which represents the majority of acute aortic syndrome aetiologies and carries dreadful outcomes. Start studying AIT 2-2 Syndromes with acute chest pain (aortic dissection, acute myocardial infarction, pneumothorax). Nevertheless, in patients with AMI secondary to AD, the omission diagnostic rate of AD has been as high as 30% (3). Patients with AD with an ST-elevation on electrocardiography (ECG) … The right coronary artery is more commonly involved and results in inferior myocardial infarction. J Cardiothorac Surg 2011; 6: 101. The incidence of LVFWR has decreased dramatically over the years with the increased use of reperfusion strategies such as percutaneous coronary intervention (PCI) and fibrinolytic therapy, with an overall incidence ranging from 0.8% to 6.2% []. of acute myocardial infarction and remote myocardial infarc- ... includesMI,acutegastritis,pulmonaryembolism,anxiety,aortic dissection, and musculoskeletalchest pain. Aortic dissection can be presumed in patients with symptoms and signs suggestive of myocardial infarction but without classic electrocardiographic (ECG) findings. Soft tissue contrast improved on diagnostic panels/DICOM images. Anti-Impulse therapy: Use IV beta-blockers or calcium channel blocker. We describe a patient treated with thrombolytic therapy for an inferior myocardial infarction caused by an acute ascending aortic dissection. Discuss the areas at risk in the heart with occlusion of each main coronary artery. In this report, we present a case of interventricular septal dissection (IVSD) following inferior wall myocardial infarction (MI) in a 64-year-old patient; the patient ultimately recovered after prompt resuscitation and intervention, despite the high mortality associated with these cases. A 40-year-old woman with no prior history presented in our emergency department with sudden chest pain. The symptoms of aortic dissection may be variable and can mimic other more common conditions such as myocardial ischemia. A successfully thrombolysed acute inferior myocardial infarction due to type A aortic dissection with lethal consequences: the importance of early cardiac echocardiography. A diagnosis of myocardial infarction was made. Here, we examined the relationship between SBP and in-hospital deaths in AAD patients.Methods: 703 AAD patients were enrolled from January 2014 to December 2018. Aortic dissection; Excess demand on the heart (hyperthyroidism, anemia) Epidemiology. Among patients suffering from acute myocardial infarction, 70% of fatal events are due to occlusion from atherosclerotic plaques. An ECHO demonstrated a pericardial effusion. A successfully thrombolysed acute inferior myocardial infarction due to type A aortic dissection with lethal consequences: the importance of early cardiac echocardiography. Around 0.5% of patients presenting to an emergency department with chest or back pain suffer from aortic dissection . In one of these five patients (patient 7), despite successful stenting, temporary prestenting obstruction of the right coronary artery was associated with periprocedural inferior left ventricular myocardial infarction (concentration of creatine kinase, myocardial bound, 59.5 U/L) and right ventricular dysfunction. Acute Aortic Dissection (AAD) is a life-threatening condition, which presents with a wide variety of symptoms ranging from being asymptomatic to sudden cardiac death. An inferior infarct was confirmed, but had occurred secondary to an acute, proximal aortic dissection with a complex intimal flap.

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